ArticleSocial psychiatry and psychiatric epidemiology2026
Age-period-cohort effects on suicide mortality in Andalusia, Spain (2000-2024): demographic masking and sustained pandemic excess.
Article in Social psychiatry and psychiatric epidemiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo analyse suicide mortality trends in Andalusia, Spain (2000-2024) through age-period-cohort (APC) decomposition, identify trend change-points, and quantify pandemic-associated excess mortality.
methodsThis population-based study used Spanish National Statistics Institute data (INE; heading 098, ICD-10 × 60-X84). Age-standardised rates (European Standard Population 2013) were computed by sex. Methods comprised joinpoint regression, Prais-Winsten modelling, an APC model (intrinsic estimator), and a log-linear counterfactual projecting the 2000-2019 trend onto 2020-2024, with quasi-Poisson and age-range sensitivity analyses.
results18,350 suicide deaths were recorded (77.4% male). Crude rates remained stable (EAPC = - 0.12%, p = 0.615) whereas age-standardised rates declined significantly (EAPC = - 0.96%, p < 0.001), revealing demographic masking. Joinpoint regression identified a single change-point reversing the long-term decline, at 2018 for both sexes (EAPC - 1.67% to + 2.65%) and 2019 for men (- 2.01% to + 3.84%); neither post-reversal segment reached significance. The APC model (adults aged 40-84; deviance R² = 0.983) showed an ascending age gradient, a period nadir in 2015-2019, and declining cohort risk. The counterfactual estimated 783 excess deaths during 2020-2024 (O/E = 1.23, 95% CI 1.20-1.27; p < 0.001), concentrated among those aged 15-64.
conclusionThe age-standardised decline reached its nadir around 2018-2019 and reversed thereafter; relative to the projected pre-pandemic trend, the pandemic period (2020-2024) showed a sustained excess without attenuation over the five years observed. These findings support age-targeted prevention; provincial heterogeneity warrants formal subnational analyses before recommending geographically differentiated strategies.
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